Just a year ago, a senior US Army psychologist complained about malingering soldiers back from the wars in Iraq and Afghanistan. Far too many were looking for handouts from the government because of mental trauma suffered on the battlefield, she wrote. Her solution for post-traumatic stress disorder was simple: "Refrain from giving a diagnosis of PTSD straight out," she told Army mental health specialists and social workers. The military has had a complete about-face since then.
Suddenly, it is throwing $900m (£640m) at the problem of battlefield trauma, and the walking wounded ignored for generations are being lavished with first-class care. Victims of PTSD in the Army alone outnumber all the wars' amputees by 43 to one. There were four suicides at the elite officer-training school of West Point in recent months and the Army immediately promised that those seeking help for mental problems would not be penalised. Last year, Robert Gates, the Defence Secretary, suggested honouring PTSD sufferers with the Purple Heart, the medal created by George Washington for wounds in combat.
The military is also buying more helicopters to get wounded troops out of Afghanistan faster, and is now treating brain injuries immediately, using hyperbaric oxygen chambers used to combat decompression in divers. There are 20 new sites to deal with mental health and traumatic brain-injury (TBI) issues and 2,700 care providers have been trained about PTSD and TBI caused by the shockwaves of explosive devices. They can have a horrific impact.
But some former servicemen and their families complain bitterly that the government isn't doing enough for them. Many victims of combat stress are homeless and are among the estimated 10,000 veterans living under motorway bridges and in shelters across the US. Many older veterans never had counselling and still carry demons from the Vietnam era.
The ranks are being swollen with combat veterans from Iraq and Afghanistan who are coming home to find a bankrupt economy where even menial jobs are hard to find. Suicide among traumatised veterans is as rampant as domestic violence resulting in manslaughter.
John Needham, a 25-year-old private from California, suffered shrapnel wounds in Iraq. He attempted suicide and, sent home after a medical discharge, he was charged with beating his girlfriend to death. Nine members of the Fourth Brigade Combat Team in Fort Carson, Colorado, have either killed or been charged with killings since returning from Iraq. Charges of domestic violence, rape and sexual assault have risen sharply.
It took a Washington Post exposé into the mistreatment of combat veterans at Walter Reed army hospital in Washington, America's leading military medical facility, to shake the high command into action. The newspaper found the guarded military hospital filthy and infested with rats, with unqualified personnel tending badly injured patients, including those with mental injuries.
At the height of the Iraq war, 20 to 40 soldiers a month were being evacuated with mental problems and sent to Walter Reed where treatment was negligible. Heads eventually rolled and an outcry from presidential candidates, including Barack Obama and John McCain, made clear that the shoddy treatment of veterans returning with physical and mental injuries would not be tolerated.
US military culture is such that even seeking help for combat stress can be enough to endanger a soldier's career. Under pressure, the Pentagon was forced to grapple with the problem and race to open treatment centres.
The US Army said at least 128 soldiers killed themselves in 2008, the fourth year in a row that suicide rates had risen, and the highest level in almost 30 years. Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, said: "That does not take into account vets anywhere else who committed suicide. We think those numbers are much higher."
A Pentagon study showed that 11 per cent of Iraq veterans and 20 per cent of Afghanistan veterans suffer from PTSD. A study by the Rand think-tank concluded that there were 300,000 victims in all. The effects range from temporary readjustment problems to suicide and murder, both of which have reached alarming levels among soldiers returning from duty. Last year, 121 war veterans were found guilty of murder or accused of it.
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